Tuesday, January 10, 2017

Stethoscopes and bad outcomes

They are not simple affairs and to suggest otherwise is to do a great disservice to the people.

Doctors have set down their stethoscopes, set aside the Hippocratic Oath, set upon the national government, and refused to see or treat the patients in their care. They demand the implementation of a comprehensive bargaining agreement, CBA, signed between them and the government in 2013. Few, if any of us, have seen a draft of the CBA and fewer still, if any, have a firm grasp of the terms of the CBA, including whether its implementation will be for the benefit of the people.

Few in the Government, whether it be the national or county government, has the moral authority to declare that what the doctors have done is immoral. Whenever the State officers in the national and county governments fall ill, serious or not, they jet off to foreign lands for their treatment. Needless to say, this comes at great public expense. The majority of the people they govern have access only to shambolic public facilities and expensive private facilities. Few have access to the gold-plated medical insurance policies that enable deputy governors to have casts put on their broken legs, governors to have Elastoplast removed from their faces, presidential nieces from having their stage 1 cancer treated overseas or cabinet ministers from having their stage 3 cancer treated by the best oncologists in the world.

The vast majority of Kenyans self-diagnose and self-medicate, often with tragic consequences. The vast majority of Kenyans have access to health facilities with no water, no electricity, no medicine drugs and few qualified healthcare workers. Regardless of the national government's promise to keep costs down, most Kenyans must pay for many services offered in public hospitals. It used to be called "cost-sharing" and it is an admission that the healthcare "system" that Kenyans have access to is a system only in name.

Whether doctors are remunerated fairly or not is part of the grand conversation regarding the cost of the entire public service, a vast undertaking employing hundreds of thousands of men and women, the vast majority of whom face the same dire healthcare challenges that the Kenyans they help govern face every day. Teachers and university dons have gone on strike in the past to enforce the terms of CBAs that the Government had attempted to set aside. The last time teachers held the Government over the barrel not even High Court orders brought them back to the table until their demands were met. What makes the teachers' strike strikingly different from the doctors' strike today and the nurses' strike in 2015 is that no one died because they hadn't been coached on their KCSE or KCPE.

I don't know if patients have died in the previous month because they didn't have doctors to treat them. This is a remarkable admission in and of itself because patients routinely die in public health facilities because of, quite often, preventable causes. One of the most striking images from the doctors strike were the facilities available to doctors in some hospitals for sterilisation before going to perform surgeries. They are grossly inadequate and explain why, even when surgeries have been successfully completed, patients still seem to die.

The solutions to this particular strike are not impossible to achieve but they are harrowingly difficult. It is time to admit that the devolution of healthcare has been cocked up six way to hell. The devolved government has proven woefully inept, tribalising the county public services, nepotising public office and corrupting the public procurement system and thereby sowing discord, confusion and suffering, and creating village millionaires overnight. The national government has not covered itself in glory either. It has actively sabotaged the devolution of healthcare, interfered with the lucrative procurement of medical equipment, mucked about with the financial accounting for healthcare funds and studiously refused to even contemplate the completion of a comprehensive healthcare policy that will put to rest the lingering questions on the persistent challenges of the healthcare "system" in Kenya.

#LipaKamaTender is a catchy hashtag that captures the zeitgeist of the banditry that is tenderpreneurship of the kind practiced with the National Youth Service or the Ministry of Health's "mobile clinics", which aren't mobile or clinics. But it glosses over the fact that without the full and unqualified buy-in by the national government in the finalisation and implementation of a comprehensive healthcare policy, even if the doctors get their pay-rise, in the long term, the people will suffer ever more greatly. Without a comprehensive policy, it is impossible to argue that a pay-rise, the employment of more healthcare workers and the acquisition of new medical equipment will ensure that the healthcare of Kenyans is the best.

By all means, healthcare workers have every right to campaign for better terms of service. But if that is all that the strike is aiming to achieve, we shall have done a great disservice to ourselves. I scoffed at the idea that we could compel State officers and members of their immediate family to only use public facilities. I thought it was cruel to subject innocent Kenyans to the vagaries of policy choices made by their spouses, siblings or parents. I am no longer so sure I was right. In fact, I think I was absolutely wrong. State officers have made countless policy decisions that have affected millions of Kenyans. It is time these same State officers faced the results of their choices. They should be compelled to use the same facilities their policies have run down. They should face the same doctors, nurses and teachers that millions of Kenyans face. Perhaps it is the only way that we will make and implement proper policies for the benefit of all Kenyans, and not just a privileged few.